MENISCAL REHABILITATION

Closed kinetic chain exercises Pain free leg press (Fig.5) and step up exercises can be introduced in the later part of the rehabilitation schedule. These more func- tional weight-bearing exercises provide stimulus to quadriceps, hamstring and calf muscles, concentrically and eccentrically, as well as providing a proprioceptive stimulus.

can successfully continue with handling skills during the early stages of rehabilitation. As the recovery continues, elements of goalkeeper specific training such as fast footwork, jumping, and eventually diving, landing and returning to the upright position immediately need to be introduced before returning to full time training, which brings in other components such as collision and opposition.

Figure 5: Leg press - a closed kinetic chain exercise

Proprioceptive exercises Impaired joint ‘position’ sense - proprioception - occurs in any type of joint injury. Meniscal injury and subsequent surgery will therefore have a derogatory effect on the afferent/efferent stim- ulus/response cycle, so re-training and rehabilitation of the neu- romuscular system is a vital component of the post-operative schedule. Most of the research in relation to proprioception and the knee joint has been performed in connection with anterior cruciate ligament injury, yet many of the conclusions also have bearing on many other injuries that occur in the knee. For exam- ple, quadriceps contraction, a vital part of any knee rehabilitation programme and which is driven by afferent information, has been shown to reduce the strain produced in the medial compartment of the knee joint when a valgus force is applied (3).

In relation to the knee joint, close kinetic chain (CKC) exercises challenge the dynamic proprioceptive responses in the lower limb. These include: ● Leg press ● Squats ● Lateral bounds ● Vertical jumps ● Step ups

And more functional activities such as: ● Circle and figure-8 running ● Slalom runs ● Carioca (crossover work) ● Dynamic stretching ● Sport-specific ball work.

Sport-specific exercises Rehabilitation of the injured athlete is incomplete until sport- specific and position-specific manouvres have been successfully introduced before returning to full time training. These need to be completed at MAXIMUM intensity without pain or loss of function. For example a goalkeeper in football following meniscal surgery

16 SportEX Figure 6: Sports-specific exercise

Isokinetics Isokinetic dynamometers are often used in the rehabilitation of lower and upper limb injuries in the injured athlete. They can also be used following meniscal surgery. In direct contrast to the reha- bilitation equipment mentioned in the previous section though, isokinetics units are very expensive and so use of them is limited dependant on accessibility. Unlike conventional weight systems where the resistance is fixed and the speed of movement is vari- able, the isokinetics dynamometer applies the opposite effect - the speed of movement is fixed and the resistance varies, being dependant on the torque applied by the player. In the rehabilita- tion schedule outlined previously, isokinetics dynamometers can be utilised in several ways for the injured athlete following menis- cal surgery. ● Active assisted bouts of work encourage sub maximal contrac- tion of the relevant muscle groups (Fig.7). Active assisted work can also be used later in the rehabilitation programme to re- educate sub-maximal eccentric work.

● Isometric work in sitting or prone lying enhances the stabilis- ing effect (Fig.8). Concentric/eccentric rehabilitation protocols reciprocate normal movement patterns.

● CKC work using leg press mode of action (Fig.9).

From this numerical data, graphs can be produced which may be used as baseline results or for comparative information.

It is important to develop functional patterns and rehabilitation schedules related to the athlete’s sport and to correct any deficits on pre/post operative testing. The physiotherapist must think later- ally and relate all isokinetics work to the specific nature of the sport.

Rehabilitation differences between menisectomy and meniscal repair For the benefits of the varying surgical procedures following